We don't know yet whether Washington politicians will be able to force complete take-over of our health care delivery system or not. One day the media slants toward a collapse of Obama's plans to transform our current system and the next day, word of the ongoing back room deals and arm-twisting in spite of our will hint that a massive change in how, when and where we receive health care services is inevitable. As Congress and the Oval Office continue their political posturing and theater, as individuals, some of us may have been able to prevent what may be coming our way.
Just before the '08 election, an acquaintance of mine told me she was voting for Obama. This woman has always vowed allegiance to the Republican Party and conservative values. She told me the reason she was voting for him was because of his health care reform platform. She and her husband retired several years ago and they have selected a health insurance policy that requires a $2000 annual deductible, per insured, which allows them a lower cost premium schedule. In the year leading up to the '08 election, this woman found herself in need of 2 biopsies, several ultrasound exams, 2 different mammography exams and several visits to a number of physicians because of a suspicion of breast cancer. Happily she did not have breast cancer. Her out of pocket expenses included the $2000 deductible, and 20% of other costs, per her insurance coverage. She noted that she was able to negotiate a portion of that 20% with the different providers and in the end, she probably only paid between 12 and 15% of her share. This is a person that enjoys a comfortable lifestyle, has money to travel extensively, drives a new luxury vehicle every 2-3 years and would, from all appearances, be a person able to bear some cost for her treatment during this incident. Thinking she would be so grateful and relieved at her benign diagnosis, I asked why her story translated into support for the government to impose the public option. She explained that she does not believe it should cost her anything toaccess and receive health care services. During that conversation in August '08, she was completely serious in telling me that she lives in the richest country in the world, has paid taxes all her life and in exchange, she should not have to spend any of her retirement income on doctors and hospitals. It is her right to receive the best care possible on demand. To this day, she believes she is entitled to a system that is completely cost free to her. I recently pointed out to her that we are quickly moving away from being the richest country in the world. I further explained that we will all experience a reduction in services and will be forced to start paying for the proposed plan years before a single person realizes a benefit. I told her that when she is moved into the government system, the HHS Secretary will actually determine whether or not, at her age, if it's a good investment to allow my friend those 2 biopsies, several ultrasounds and many office visits, or if such an intensive diagnostic plan is simply too expensive for the system. She thinks I'm ill-informed on the issue.

Another friend of mine is an ER nurse in California with nearly 40 years experience in her field. She recently did an intake evaluation on a man presenting with a minor stab wound. A Spanish interpreter was called in as he could not speak English. As his story unfolded, she learned that he had entered California illegally several years ago, had been able to get a Social Security number although he added he had done so without ever having completed immigration paperwork. He has a long history of drug addiction and heavy alcohol use along with serving some time off and on in California prisons. As his medical and social history continued to emerge, he smiled broadly at my friend when he relayed to the interpreter that he has enjoyed all of the 'goodies America has to offer him'. The 'goodies' he was referring to were assistance with housing, the WIC program for his 2 girlfriends and the children he has with them, food stamps, and of course, free health care anytime he so requires.

In our family, we have a number of elderly relatives in their mid to late 80's. One in particular is a person that consumes health care services as a way to socialize and reach out for human contact. This individual lives alone and rather than volunteer at the local schools, churches, library, hospitals or nursing homes, she chooses instead to visit several different doctors on a regular basis as a way to interact with people and have someone inquire as to how she is doing. Every twinge or slightest pain sends her to a doctor. A mild case of dermatitis caused by dry winter air doesn't prompt her to try an over the counter cream that her pharmacist believes will solve the problem. She sees her primary care physician and insists on a referral to a dermatologist. And so it goes. Each visit to each physician amounts to a claim filed with Medicare and her supplemental insurance carrier. After each entity has processed her claim, she ends up paying a few dollars of the many hundreds of dollars that each imagined medical crisis costs. This individual is also a person that if means testing were put in place, it would be determined that she certainly could cover a greater load of the costs she imposes each month on our system. The assistance she receives as a result of Pres. Bush's drug benefit legislation for seniors, along with Medicare and other supplemental coverage keeps her out of pocket expenses for drugs, testing and office visits to about $1000 per year, which is a bargain compared to the 10's of thousands charged and written off under her specific coverage plans. In her mind, she, too is entitled to no-cost health care after contributing to society for years as a taxpayer. At the same time, as a taxpayer she also feels as most of us do that our taxes should also pay for good schools, nice smooth roads, safe bridges, ample police and fire protection and other civil services. She hears the news and knows there are budget deficits across the entire spectrum of government and that cuts must be made. She believes, however, that cuts should affect every one but her and she has no qualms about piling on debt that her grandchildren and great-grandchildren will soon inherit. Along the same mindset, another aging relative decided he needed a cane just in case at some point he had some difficulty walking. He priced out the canes available at his local pharmacy and didn't want to pay $25, so instead, he scheduled a visit to his primary care doctor and asked for a prescription for a cane. The doctor questioned why it was needed, but after the patient persisted, the script was written and filled by a medical supply facility at a cost to the Medicare system of over $100. Again, this person is also financially able to buy the cane for himself rather than shift the cost to our bankrupt government system and those that will bear the debt for decades to come.

I believe our president and his Democrat controlled Congress will impose health care reform on our country, of one form or another. Can a cleaning of the House and Senate in November be enough for us to turn it back? We don't know that as yet. One thing is for certain, however. If individual Americans along the way toward this end had taken some personal responsibility and used some common sense in their individual utilization of health care, our costs would be lower today.

As a society, many Americans have lost sight of their own individual contribution to sky rocketing health care costs. For each person that receives an entitlement, others must bear the cost. It's been easy to ignore that fact. We forget that when an insurance company or Medicare or Medicaid "writes off" a charge, that dollar amount simply doesn't just go away. It must be paid and that happens by passing along those costs to insurance companies and their clients and private payers. There will always be citizens that cannot afford to pay for health care, and as a benevolent nation we've done a fairly decent job in caring for those people. Others that do have the financial means to care for themselves have decided free and reduced cost care would allow them more money for other luxuries. Persons here illegally have also been able to come to the trough and get care, often without paying anything.

Many have climbed aboard the train, demanding a window seat and first class accommodations. There are too many passengers stuffed into fewer and fewer cars and the train is now so overburdened, it is slowing to a stop. There is no longer enough money to shovel into the engine to carry the huge load. If some of us had jumped off along the way, making room for our legal citizens that truly needed subsidized care, maybe government-run, unfunded, limited access healthcare wouldn't be headed toward us now at light rail speed.